Kidney surgeon fails to attend hearing

TWO surgeons cleared of killing a patient whose only healthy kidney was wrongly removed at a Welsh hospital were yesterday accused at a disciplinary hearing of "abject, needless and inexcusable" negligence.

TWO surgeons cleared of killing a patient whose only healthy kidney was wrongly removed at a Welsh hospital were yesterday accused at a disciplinary hearing of "abject, needless and inexcusable" negligence.

Leighton Davies QC, for the General Medical Council, said the actions of consultant urologist John Gethin Roberts and medical registrar Mahesh Goel fell far below the standard of care expected of reasonable and competent surgeons.

Mr Roberts, of Pastoral Way, Sketty, Swansea, oversaw the operation while Mr Goel, who is in India and not present at the hearing yesterday, carried out the procedure.

John Graham Reeves, 69, had his good left kidney removed by the two surgeons instead of his chronically-diseased right one.

Mr Davies said Mr Goel and Mr Roberts were guilty of serious professional misconduct "because of their thoughtlessness and want of due care".

Their negligence was "so abject, needless and inexcusable" and "so far below the standard of care to be expected" that it went far beyond anything that could ordinarily be covered by compensation.

The GMC's professional conduct committee heard that the operation on the Korean War veteran took place at the Prince Philip Hospital in Llanelli on Monday, January 24, 2000.

Mr Reeves died on March 1 five weeks after the operation, despite two more operations and emergency dialysis.

Both surgeons were found not guilty of manslaughter under the judge's direction at Cardiff Crown Court in June 2002.

The prosecution's case collapsed after a key witness, pathologist Dr Andrew Davison, told the court he could not be sure Mr Reeves died as a result of the blunder.

Mr Davies told the committee Mr Roberts was head of the Department of Urology at the Prince Philip Hospital.

Also working in the department were Mr Goel, registrar, as well as a Mr Umasankar, a senior house officer, consultant anaesthetist Dr Douglas Richards and a junior doctor.

Mr Davies drew attention to what he said was "a fateful quirk" in the chain of events leading up to Mr Reeves's operation.

It was normal practice for Mr Roberts, Mr Goel or Mr Umasankar to enter up-coming operations into a diary, he said.

But according to Mr Roberts's secretary, the entry for Mr Reeves's January operation indicated he was to have his good left kidney removed, not his right one, Mr Davies said.

The QC added that the secretary claimed the entry was in Mr Goel's handwriting.

Mr Davies said that Mr Goel explained the erroneous entry by saying he had copied it from an administrative slip completed by Mr Umasankar.

This was something he should "never, ever have done", he added.

The committee heard that Mr Roberts admitted all the factual charges against him, apart from disputing whether the X-rays he received before the operation were correctly labelled.

But he denies his actions amount to serious professional misconduct.

Mr Goel has admitted a number of charges, including seeing Mr Reeves in clinic in July 1999 where tests showed that the patient's right kidney was not functioning.

But he also denies serious professional misconduct.

Outlining events leading up to the blunder, Mr Davies said the removal of the healthy left kidney was a "drastic surgical error" which was described the day after by Mr Roberts in a written report for an internal inquiry as an error "which was appalling".

The committee was told Mr Reeves left the operating theatre at around noon and had been taken to the intensive therapy unit of the hospital.

The alarm was first raised at 2.30pm when it was noted that Mr Reeves had not produced any urine - the principle function of the kidneys.

It then became apparent that the left kidney had been removed instead of the right one, Mr Davies told the hearing.

"It was his left kidney which was keeping him alive," the QC said.

"After that operation in the morning of January 24, 2000 his body, in effect, was left with no kidney or renal function whatsoever."

The surgically-removed healthy kidney was placed in a sterilising agent which meant it was not possible to attempt a re-implantation into the patient's body.

Mr Roberts explained the situation to Mr Reeves in the intensive therapy unit and obtained his consent to carry out a second operation that afternoon, the hearing was told.

The second operation involved inserting a tube or a "stent" into the right kidney.

It was a "desperate attempt to achieve some sort of activity in that kidney that was an attempt which was doomed to failure - but at the same time we don't say that it was wrong," Mr Davies said.

On February 17 the right kidney was surgically removed at the Morriston Hospital.

An X-ray taken on February 27 showed he had Adult Respiratory Distress Syndrome (Ards). On March 1 he died.